Monthly Newsletter | August 2023

Welcome to all the faculty and fellows who recently joined DHM in July! Onboarding season is always a highlight of the year, and we look forward to working with and getting to know all of you in the weeks and months ahead! We will welcome the second batch of new faculty in September.

Meet DHM

Get to know our division by reading our faculty and staff interviews!

Sara Murray was named Chief Health AI Officer for UCSF Health.

Sunny Kishore was on the podcast House Calls with Surgeon General Vivek Murthy along with Dave Chokshi in a session focused on the concept of the Moai — a powerful friendship tradition that has sustained each of them over the years.

Alex Beagle, a recently graduated UCSF Internal Medicine resident, was awarded the Distinguished Professor of Hospital Medicine Best Oral Abstract Award for an abstract presented at the 2023 Society of General Internal Medicine Meeting. This study, conducted with DHM co-authors Kirsten Kangelaris, Priya Prasad, Sandra Oreper, Yumiko Abe-Jones, and Margaret Fang, explores differences in volumes of initial intravenous fluid resuscitation for sepsis with findings suggesting that appropriate fluid volume administration for patients with history of heart failure may be less than in those without a history of heart failure.

Adria Jimenez-Bacardi of UCSD (former DHM), Bassem Ghali, and Sunny Kishore successfully advocated for the inclusion of oral acamprosate and both oral and injectable naltrexone in the World Health Organization's Essential Medicines List (EML). The WHO EML comprises essential treatments considered high priority, which should ideally be available for free or at affordable prices worldwide. Notably, this marks the first time that Alcohol Use Disorder (AUD) has been officially recognized by the WHO in this list.

UCSF School of Medicine and UCSF Health recently requested proposals from faculty to fund social events that will improve faculty experience by strengthening bonds among our teams. Tim Judson and Sangeeta Bhat were two faculty with winning proposals. Tim's event will focus on faculty and staff living in the North Bay and Sangeeta’s event will be for the St. Mary's core faculty. 

DHM Social Activities

The Faculty/Staff Appreciation Day at the Giants game is on Wednesday, September 13 at 12:45pm at Oracle Park (SF Giants vs. Cleveland Guardians). The evite will be sent out soon!

A "pearl" in promoting Equity and Belonging is a short, action-oriented, topic that aims to raise awareness, increase concern, and share strategies to mitigate our institutional inequities and promote inclusion.

Every month beginning in August 2023 we will be highlighting one hypothetical scenario together with Celeste Futch from the Health Advocate Program to illustrate how to build a Relational culture in hospital medicine. These scenarios may be based on real patient encounters shared by Celeste. At UCSF, we have measured racialized disparities for patient experience, pain management, length of stay, and readmissions. Some of that data is highlighted in the July 10 presentation for DHM Monday Faculty Development about the Health Advocate Program. The pearls from the Newsletter will each be a unique aspect of the inequities and disparities gaps. Each pearl will provide tangible ways to transform practice, building a toolkit for practicing with relational culture — manifesting power with — in hospital medicine.  

A patient is awakened by the night hospitalist. "Are you okay?" Groggy and startled, the patient responds to the doctor that they are doing fine, no chest pain, no shortness of breath — except now that they are awakened they are experiencing uncontrolled pain and would like to request treatment. The patient then overhears the doctor in the hallway tell their nurse that a "one-time" dose of pain treatment will be prescribed: "I'm not ordering any more, this is one-time only." The patient interprets this conversation negatively and feels terrible hearing the doctor speak about them to the nurse in this way. They cannot go back to sleep, suffering with uncontrolled pain the remainder of the night. In the morning, the patient does not share this experience with their primary team because they do not want to jeopardize the great care the day team has been providing, including managing their pain and treating them with respect and dignity. Only after they are discharged home do they share this experience with their Health Advocate, who called for a standard post-discharge dialogue about their hospital experience. "One-time" orders were never explained to the patient, and they believed it was because of their racial background that the doctor would order medicine in that way for them.

This hypothetical patient scenario is based on a real situation highlighting an opportunity to build relational culture. We define relational culture as a manifestation of power with rather than power over. Cross-covering patients on hospital medicine services means placing one-time orders occasionally, a safe and appropriate practice. Here is an opportunity to build relational culture with transparency and shared leadership practiced by the care team explaining the “one-time” ordering practice of cross-covering physicians. In juxtaposition, power hoarding and paternalism are examples of white supremacy culture that manifest in the practice of speaking in hallways within earshot of patients about them, without inclusion, without explanation, and without acknowledgment of their presence. Imagine if the day team had described the possibility of cross-covering doctors visiting to check on the patient for such things as cardiac monitoring alarms, or that placing one-time orders is common practice overnight so primary day teams can manage treatment plans together with patients when there is more time for shared-decision-making. Investing time to explain these nuances of hospital medicine can impact patient experience and is one step towards building relational culture.  

The following table will highlight more generally some examples for building relational culture as opposed to white supremacy culture, adapted from the Race and Social Justice Initiative. 

To share an example of how you are building relational culture, provide feedback or comments, or to share pearls for the next DHM newsletter, please email yalda.shahram@ucsf.edu. 

Esther Hsiang and Smitha Ganeshan were coauthors on a viewpoint article recently published in JMIR Medical Education in which they posit that immersive elective internships during medical training with digital health organizations, including start-ups, are valuable for influencing future physician-leaders and health care innovators.

Cindy Lai and colleagues published an article in Academic Medicine, summarizing the results of a national survey that found underutilization of pro-equity strategies in assessment and grading within internal medicine clerkships.

Monisha Bhatia published a study in BMC Geriatrics describing a model to predict discharge to post-acute care based on data extracted from the electronic health record within 24 hours of admission.

Cat Burke and Teddy Peng

"I worked with Cat Burke and Teddy Peng at Mount Zion over the July 4th week and was truly blown away by their willingness to go above and beyond to be good colleagues. They both helped everyone throughout the week to make the week the best that it could be. Even the nurses commented about how much they loved working with Cat and Teddy."

-Smitha Ganeshan

Physician-Nurse Communication QI Initiative 

We want to share some of the specific recognitions we have received directly from our nursing colleagues about our hospitalists' communication with bedside nurses. These quotes were anonymously submitted as free response comments by various nurses on 14L, 14M, and 15L through our ongoing RN communication survey.

"I would like to recognize how Dr. Andy Lai consistently does a great job at calling / communicating with bedside RNs for plan of care for patients. Every time I see he's my patient's attending, I am very confident that I will be giving the best care for my patient!"

– 15L RN 

"Shoutout to Dr. Erin Yao-Cohen for being so proactive with doctor/physician communication :)"

– 14M RN 

"Dr. Trevor Jensen and Dr. Stephanie Rennke were amazing. Kept me very informed and updated."

– 14L RN 

"Dr. Charles Chu made sure to call me to close the loop on the plan for one of my patient's today which was highly appreciated!"

– 14M RN 

"For Dr. Madison Paddock, communication was awesome – she called me to update on the talks with the family, we don't always get that. She called and is very team-centric."

– 15L RN 

"I really like Dr. Esther Hsiang — she has clear communication and explains things well to her patients!"

– 14M RN 

"Dr. Ethel Wu is great, always super up to date, easy to get a hold of."

– 14M RN 

"Dr. Brad Sharpe is the best — he always calls, always washes his hands, always tells me things."

– 14L RN

Thank you for your continued engagement in efforts to improve physician-nurse communication! 

– Sarah Flynn and Esther Hsiang, Improving Physician-Nurse Communication QI Initiative Champions